1,720,972 research outputs found
Children with Prepubertal Anorexia Nervosa: assessing the sex hormone profile and prognostic factors for inpatient treatment outcomes.
No full textBACKGROUND: Even though Anorexia Nervosa (AN) is an emerging research topic, scarce literature data are available on children with prepubertal AN. To date, no specific study has assessed the potential prognostic factors on treatment outcomes in this population.
METHODS: Observational, retrospective study of 39 children (12.5±1.8 years) hospitalized for AN, with primary amenorrhea and absence of pubertal development at clinical examination. Sexual hormonal profile: plasma levels luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), progesterone (P4), and prolactin (PRL) were assessed at admission. Clinical (age, duration of illness, comorbidity, admission body-mass index - BMI), treatment (psychopharmacological therapies) and outcome (BMI improvement, length of hospital stay - LOS) variables were assessed. Multiple linear regressions were conducted to assess potential predictors of outcomes.
RESULTS: A predictive model of BMI improvement (F(4, 32)=8.713; Adjusted R2=0.491; p<0.001) was documented, with longer LOS (B=0.010; p<0.001), lower plasma levels of E2 (B=-0.043; p=0.002) and lower plasma levels of LH (B=-0.292, p=0.043) predicting a greater BMI improvement. A predictive model of LOS (F(2, 38)=9.527; Adjusted R2=0.310; p<0.001) was documented as well, with younger age (B=17.835; p<0.001), and reduced BMI improvement (B=22.656; p=0.012) predicting a shorter LOS. No predictive value of comorbidity, FSH, P4 or PRL was found.
CONCLUSIONS: This is the first study to investigate the prognostic value of sex hormones on the treatment of children with prepubertal AN. Low E2, LH, and age, but not FSH, P4 or PRL, were associated with better outcomes. These data should be investigated in wider populations and controlled studies
Low-Dose Olanzapine in the Treatment of Adolescents with Anorexia Nervosa: An Observational Naturalistic Case-Control Study
Get PDFBackground: Although recent articles have investigated the use of low-dose olanzapine in different psychiatric conditions, only one study so far has assessed this treatment in 13 girls with anorexia nervosa (AN). Methods: Observational naturalistic case-control study aimed at reporting the use and tolerability of low-dose olanzapine in the context of a multidisciplinary hospital intervention for adolescents with AN. Three groups with AN were compared: group 1 was treated with low-dose olanzapine (≤5 mg/day), group 2 with full-dose olanzapine (>5 mg/day), and group 3 (control group) was treated without antipsychotics. Psychopathology was assessed at admission (T0) and discharge (T1) with Eating Disorders Inventory-3 Eating Disorders Risk, Body Uneasiness Test Global Severity Index (BUT-GSI), Beck's Depression Inventory-II (BDI-II), and Self-administered Psychiatric Scales for Children and Adolescents, Depression subtest (SAFA-D). Possible differences among the three groups, concerning clinical and treatment variables, were screened. Then, potential differences of T0-T1 modifications in psychopathological variables among the three treatment groups were assessed with analyses of covariance, corrected for baseline psychopathology and potential confounders, including possible concurrent antidepressants. Results: A total of 118 patients were enrolled (F = 94.1%; mean age = 15.4 ± 1.7 years), including 52 controls, 37 treated with low-dose olanzapine, and 29 with full-dose olanzapine. Low-dose olanzapine was well tolerated and used for a mean of 132.1 (±98.6) days, starting with a dosage of 3.4 (±1.2) mg/day and increasing to a maximum dose of 4.4 (±1.1) mg/day. The multidisciplinary intervention resulted in an improvement of BUT-GSI (p < 0.001), BDI-II (p < 0.001), and SAFA-D (p < 0.001) for the entire sample. Individuals treated with full-dose olanzapine experienced a significantly lower improvement in depressive measures: BDI-II (F[2,61] = 12.653, p < 0.001, η2 = 0.269) and SAFA-D (F[2,57] = 7.413, p = 0.001, η2 = 0.170), than the other groups. Discussion: This naturalistic controlled study expands the existing evidence on the use and tolerability of low-dose olanzapine in adolescents with AN. These results should be assessed in wider and prospective samples
The Role of Mood Stabilizers in Children and Adolescents with Anorexia Nervosa: A 1-year Follow-Up, Propensity Score-Matched Study
Get PDFBackground The existing literature on the use of mood stabilizers (MS) in children and adolescents with anorexia nervosa (AN) is limited, for the most part, to small case studies. Methods This was an observational, naturalistic, propensity score-matched study. Subjects treated and not-treated with MS were compared by being matched via propensity score on age, sex, concurrent atypical antipsychotics, and concurrent antidepressants. General and AN-specific psychopathology was assessed with Symptom Check List-90-R, Beck Depression Inventory-II, Eating Disorders Inventory-3, and Body Uneasiness Test-A. Potential differences in admission-discharge modifications (body mass index (BMI), psychopathology) among the two groups were assessed. Finally, re-hospitalizations after 1-year follow-up were assessed with Kaplan-Meier analyses. Results The study enrolled 234 hospitalized patients (15.9+/-3.3 years; 26, 11.1% receiving MS). After propensity-score matching, 26 MS patients matched with 26 MS-not-treated subjects were included. MS were used for a mean of 126.1 (+/-87.3) days, and two cases of side effects were documented (alopecia and somnolence with valproate). No significant difference between MS-treated and not-treated patients emerged concerning admission-discharge improvements in BMI and AN-specific or general psychopathology. The cumulative survival from re-hospitalization at 12 months was 64,4% (95%-CI, 31.3-97.5) for MS and 58.7% (95%-CI, 22.2-95.2) for MS-not-treated subjects. No significant difference in survival rate emerged (hazard ratio, 0.04; Log-rank test: p=0.846). Conclusions This propensity score-matched study expands on the scant existing evidence of the use and side effects of MS in children and adolescents with AN. These results should be assessed in wider longitudinal samples
Antipsychotics in the Treatment of Children and Adolescents with Anorexia Nervosa: A Systematic Review
Get PDF: Evidence about the use of pharmacologic agents in the treatment of Anorexia Nervosa (AN) is lacking, especially in childhood and adolescence. A systematic scoping review was conducted to outline current literature evidence about the use of antipsychotics in this population. A total of 499 studies were identified with the initial search, and 28 of these studies were selected regarding the use of olanzapine (n = 13), risperidone (n = 4), aripiprazole (n = 3), chlorpromazine (n = 3), pimozide (n = 1) clotiapine (n = 1) and multiple antipsychotics (n = 3) in these patients. Overall, major side effects were reported infrequently; improvements in psychopathology and weight measures have been suggested in the majority of the considered studies. Nonetheless, the lack of RCT or good-quality studies strongly limits the generalizability of results in clinical practice
Eating Disorders in Infants and Toddlers
No full textAdequate feeding represents an important function of regulation during childhood. Early, transient feeding problems are common among normally developing infants. Paediatricians and child neuropsychiatrists should recognize enduring feeding difficulties, since they cause negative effects on children’s growth and development. Feeding disorders (FD) might be the result of a lack of balance among parents’ feeding style, organic causes and child behaviour. FD present a clinical spectrum from mild to severe. Among FD, avoidant/restrictive food intake disorder (ARFID) represents a newly introduced diagnosis in the DSM-5. Patients with ARFID present restrictive eating behaviour, persistent difficulty in meeting nutritional needs, in the absence of body image disturbances. FD, as selective or scarce feeding, may represent a warning early sign suggesting an autism spectrum disorder (ASD). Children with ASD are five times more likely to manifest FD than their peers. The management of children with FD requires collaborative care of a multi-professional team. At the present time, behavioural therapy is the mainly supported treatment for FD in childhood
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Adjunctive clotiapine for the management of delusions in two adolescents with anorexia nervosa
Get PDFClotiapine is an atypical antipsychotic indicated for the management of a series of acute psychotic disorders. The current literature lacks evidence concerning the tolerability and clinical use of this drug in the management of individuals with anorexia nervosa (AN). In this study, we report two cases of adolescents with AN, treated with clotiapine. The reason for the administration of clotiapine was, for both patients, the manifestation of bizarre delusions concerning food and calories. Patient 1 presented a presyncope after the first dose of clotiapine, and treatment was rapidly discontinued. Patient 2 was treated with clotiapine for 9 months; doses were titrated from 20 mg/day to 70 mg/day, with an improvement in the reported delusions, which also enhanced compliance with psychological and nutritional interventions. EKG, QTc, white blood count, and red blood count were not relevantly influenced by the introduction of clotiapine in either patient. No extrapyramidal effect was documented. These reports stress the need for further studies assessing the tolerability and potential effect of clotiapine in treating adolescents with AN and delusional symptomatology
Expanding the neurological phenotype of ring chromosome 10 syndrome: A case report and review of the literature
Get PDFRing chromosome 10 [r(10)] syndrome is a rare genetic condition, currently described in the medical literature in a small number of case report studies. Typical clinical features include microcephaly, short stature, facial dysmorphisms, ophthalmologic abnormalities and genitourinary malformations. We report a novel case of r(10) syndrome and review the neurological and neuro-radiological phenotypes of the previously described cases. Our patient, a 3 year old Italian girl, represents the 20th case of r(10) syndrome described to date. Intellectual disability/developmental delay (ID/DD), microcephaly, strabismus, hypotonia, stereotyped/aggressive behaviors and elec-troencephalographic abnormalities were identified in our patient, and in a series of previous cases. A brain MRI disclosed a complex malformation involving both the vermis and cerebellar hemispheres; in the literature, posterior cranial fossa abnormalities were documented by CT scan in another case. Two genes deleted in our case (ZMYND11 in 10p and EBF3 in 10q) are involved in autosomal dominant neurodevelopmental disorders, characterized by different expressions of brain and posterior cranial fossa abnormalities, ID/DD, hypotonia and behavioral problems. Our case expands the neurological and neuroradiological phenotype of r(10) syndrome. Although r(10) syndrome represents an extremely rare condition, with a clinical characterization limited to case reports, the recurrence of specific neurological and neuroradiological features suggests the need for specific genotype-phenotype studies
Cardiological Aspects of Feeding and Eating Disorders in Children and Adolescents and Associations with Refeeding Syndrome, Purging Behaviors, and Psychoactive Drugs
Get PDFFeeding and Eating Disorders (FEDs) constitute a complex spectrum of psychiatric conditions, impacting physical and psychosocial well-being. This retrospective
observational study aimed to dissect the electrocardiographic (ECG) alterations in pediatric
patients with FEDs, correlating them with clinical factors, treatment modalities, Refeeding
Syndrome (RS) and the reversibility of ECG abnormalities post-treatment. Analyzing
records from a third level Italian Regional Center for FEDs in children and adolescents, the
study encompassed 150 patients meeting the inclusion criteria. Sinus bradycardia was the
prevalent ECG alteration, notably in Anorexia Nervosa (AN) restrictive type. Association
analyses revealed links between the severity of AN, hormonal imbalances, and amenorrhea
and ECG abnormalities. Pharmacological interventions, particularly antipsychotics, exhibited associations with a QT interval prolongation. RS demonstrated significant correlations
with potassium and magnesium imbalances, which were linked to specific ECG changes.
This study highlighted the reversibility of ECG abnormalities, concomitant with Body Mass
Index improvement. This analysis underscores the critical cardiac implications of FEDs,
advocating for multidisciplinary interventions and close cardiac monitoring. Early detection and holistic care are imperative in managing patients with FEDs in the developmental
age, offering potential reversibility of cardiac alterations post-treatment. These findings
underscore the need for prospective studies to validate these observations and delve deeper
into cardiac involvement in FEDs
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